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ORANGE COUNTY ELDERLY CHORE PROGRAM <br />PROVIDER AGREEMENT <br />This is to certify that The Ri ht Staff, Inc. <br />(Name of Agency) <br />located at <br />herein after known as the Provider agency, e 2'7514 <br />P.O. Box 1613, Chapel Hill, N. C. <br />(Address) <br />on this day of Elderly <br />agrees to participate as a provider in thegr orange <br />througntJune 30, 1991. <br />Program for the period July 1, <br />agrees to provide necessary Chore servvice <br />1. The Provider agency <br />to approved recipients at $ 8.00 p e request <br />.s er hour upon n the <br />Management <br />of the Orange County Department on Aging <br />program hereinafter known as the lead Administrative <br />Aency. <br />2. The Provider agency agrees to meet all service provision <br />standards for Chore such as training as required by the <br />State of North Carolina and provide documentation upon request. <br />(Attachment Al <br />3. The provider agency agrees to provide the Chore service <br />within two weeks from the beginning service date specified in the <br />Purchase of Service Authorization on each approved recipient. <br />(Attachment B) <br />4. The provider agency agrees <br />necessary are kept to fully <br />provided to recipients fo <br />inspection. <br />to ensure that such records as <br />disclose the extent of the service <br />r four years and available for <br />5. The provider agency , agrees <br />30tdays submit <br />fromadate monthly <br />receiptafor services <br />rendered payable w ithin <br />6. The Provider agency agrees to adhere to the Inter--agency Long Term <br />Care Management Procedures in the provision of the service. <br />(Attachment C) <br />7. This agreement may be terminated by Orange County upon giving <br />30 days prior written notice or by the Provider agency upon <br />giving 30 days prior written notice. However, orange County <br />may immediately suspend a provider agency for violations of the <br />rules or regulations that govern the program or this agreement. <br />istrat' Age y Provider Agent <br />` <br />Le By <br />By: � "g to e of Agent <br />Signature o Au i ea Agent <br />Title f Auth rized Ag nu hori <br />Id <br />Title of Autze Agen <br />Date: <br />Date: <br />FN:PROVIDER.DOC <br />